ProAir vs. Xopenex

See how ProAir and Xopenex compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • ProAir and Xopenex are both short-acting bronchodilators used to relieve or prevent asthma-related bronchospasm, but they differ in formulation and delivery options.

  • ProAir is FDA-approved for exercise-induced bronchospasm prevention and comes only as a metered-dose inhaler with a built-in dose counter.

  • Xopenex delivers the single R-isomer of albuterol and is available as both a nebulizer solution and an HFA inhaler, offering more dosing flexibility for some patients.

ProAir vs. Xopenex Drug Summary

ProAir

ProAir (albuterol sulfate) is a short-acting beta2-agonist inhaler used to treat and prevent bronchospasm in asthma and other reversible airway diseases. It is taken as 1 to 2 inhalations from a metered-dose inhaler, either as needed for symptoms or before exercise to prevent bronchospasm.

Xopenex

Xopenex (levalbuterol) is a short-acting beta2-agonist bronchodilator used to treat and prevent bronchospasm in reversible airway disease. It is delivered either through a nebulizer solution three times daily or through an HFA inhaler used every four to six hours.

ProAir vs. Xopenex Side Effects

ProAir

Most common
Dizziness (up to 3%)
Pain (up to 3%)
Headache (up to 3%)
Tachycardia (up to 3%)

Xopenex

Most common
Dizziness (up to 2%)
Pain (up to 2%)
Bronchitis (up to 2%)
Pharyngitis (up to 2%)

ProAir vs. Xopenex Dosage

ProAir

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2 inhalations every 4-6h At the start
Maximum dose 2 inhalations pre-exercise If needed
Dose changes 2 increases As tolerated

Xopenex

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 0.31 mg three times daily At the start
Maximum dose 90 mcg (2 inh) q4-6h If needed
Dose changes 4 increases As tolerated

ProAir vs. Xopenex Indications

ProAir

ProAir is FDA-approved to treat or prevent bronchospasm in people 4 and older with reversible obstructive airway disease, including asthma. It is also approved to prevent exercise-induced bronchospasm in the same age group.

  • Treats bronchospasm from asthma or COPD

  • Prevents exercise-induced bronchospasm

  • Approved for ages 4 and up

  • Fast-acting rescue relief within minutes

Xopenex

Xopenex is FDA-approved to treat or prevent bronchospasm caused by reversible obstructive airway disease. It is available as a nebulizer solution and as an HFA inhaler, giving clinicians flexibility in how it's delivered to different patients.

  • Treats bronchospasm from asthma or COPD

  • Available as nebulizer solution or inhaler

  • Single-isomer (R-enantiomer) of albuterol

  • Not specifically labeled for exercise-induced bronchospasm

ProAir vs. Xopenex Pros and Cons

ProAir

ProAir is a well-established albuterol inhaler with decades of real-world use and an FDA label that explicitly covers exercise-induced bronchospasm. Its authorized generic status has made it a common first-choice rescue inhaler across most insurance formularies.

Pros

  • FDA-approved specifically to prevent exercise-induced bronchospasm

  • Approved for children as young as 4

  • Includes a built-in dose counter so patients know when to refill

Cons

  • Only available as a handheld inhaler, no nebulizer solution option

  • Contains both R- and S-albuterol isomers, unlike Xopenex's single-isomer formula

  • Fewer FDA-listed dosing regimens than Xopenex

Xopenex

Xopenex offers levalbuterol, the single active isomer of albuterol, in both nebulizer and inhaler forms. This gives clinicians more flexibility in delivery method and dose strength, though its label doesn't specifically address exercise-induced bronchospasm.

Pros

  • Single-isomer (R-enantiomer) formulation, which some patients tolerate better than racemic albuterol

  • Offered as both a nebulizer solution and an HFA inhaler

  • Multiple approved dosing strengths (0.31 mg, 0.63 mg, 1.25 mg) allow individualized dosing

Cons

  • Not specifically FDA-approved for exercise-induced bronchospasm prevention

  • No stated minimum age in its FDA label, requiring clinician judgment for pediatric use

  • Nebulizer dosing requires three-times-daily administration, less convenient than as-needed inhaler use

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